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What Nobody Tells You About ACA

The open enrollment period for health care coverage through the Affordable Care Act closed on February 15. Thanks to this legislation, 8.8 Million people now have health insurance. That’s a good thing, right? Indeed it is. What you probably don’t know is what’s expected of you now. Nobody is really talking about. However, there are big plans for you. Beyond the goal of requiring health care coverage, another goal of the ACA is to improve our nation’s health. Yep, that includes you! Reducing the overall cost of health care is another one of the goals.

coverage to care

Remember when President Barack Obama signed the ACA into law in 2010? We knew this was a huge deal, riddled with controversy. However, radical change is seldom without controversy. It was not only to bring about radical change for the uninsured, but for all Americans. In order to improve our population health and reduce the cost of health care, we all need to better understand how we should be using health insurance and healthcare services. One of the challenges that has been discovered is “people understood the importance of having insurance when you get sick, but they were less clear on the value of having insurance as a tool you can use to stay healthy” says Dr. Cara James, Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services (CMS).

Enter From Coverage To Care, also known as C2C. This initiative launched in June 2014 and is led by James and the Office of Minority Health at CMS was designed to connect consumers to healthcare services. Ultimately, helping them achieve better health outcomes. C2C provides a comprehensive toolkit that includes a roadmap and supplemental products to help you understand how to get the most out of your health insurance coverage. It solves a problem that has not been well addressed up to this point, how exactly do we get the most out of our health insurance coverage? For many of us it requires a mindset shift from only utilizing health insurance for sick visits, to focusing on well visits (defined: when you don’t feel sick) for disease prevention. The roadmap lays out 8 critical steps you should be taking. The 2 most important are understanding your health coverage and being prepared for your visit.

Understanding your health coverage offers 2 distinct benefits. One, it provides clarity on the financial implications of the plan you selected. Your coverage costs more than just the premium you pay each month. Knowing the out of pocket costs associated with Doctor’s office visits, urgent care and emergency department visits allows you to chose more wisely when you need to be seen for a health related situation. A general guideline is to think on a scale of 1-10 with 1 being minor and 10 severe. When you have a situation between 1-4, make an appointment to be seen by your primary care doctor. By the time it gets to 5-7, an urgent care visit is in order, if it’s after hours or your PCP is unable to see you. If the situation escalates to an 8-10 or is a life-threatening situation, you should proceed to the closest hospital emergency department. Bear in mind that as the situation escalates up the scale, so do the costs associated with the visit. Most insurances will only waive and emergency department visit if you are admitted to the hospital. Of course you should confirm this with your select plan.

The second benefit of understanding your coverage is knowing which preventive screenings and services are included in your plan. All health plans are now required to provide a battery of preventive screenings at no additional cost to you under provisions of the Affordable Care Act.  Going back to the mindset shift I mentioned earlier, most of us tend to think of health insurance like auto or homeowners insurance. Actually, it is designed quite differently. Auto and homeowners insurance are required and only to be used when an incident occurs, in a reactive fashion. Conversely, health insurance is designed to be used proactively or to prevent disease. In fact, you should be going to the doctor for well visits at least annually. This serves at least 2 good purposes. The primary reason is this establishes a relationship and rapport between you and the doctor. A nurse practitioner or physician assistant can fulfill this role, too. They ensure that you stay up to date on the recommended preventive screenings. That leads into the other purpose for well visits. When you’re in good relationship with a primary care provider, you’re more likely to establish health goals. This additional element of accountability will encourage you to achieve and maintain your health goals.

The roadmap and video learning materials to help you make an easy transition From Coverage to Careare found at They are free resources. One final note, if you are assessed a penalty when filing 2014 taxes because you were uninsured and not eligible for exemption, you may be able to gain health insurance coverage through a special enrollment period March 15 – April 30, 2015. Visit for more information.

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